Juan Javier-DesLoges

Background: Telehealth use expanded rapidly during the COVID-19 pandemic and has since become integrated into routine oncology care. However, clinician experiences and confidence with telehealth may vary across oncology subspecialties, and these differences remain incompletely characterized. Objective: This study aimed to evaluate telehealth perceptions, decision-making factors, and confidence across oncology clinicians from multiple specialties at a single academic cancer center. Methods: We conducted a cross-sectional survey of oncology clinicians at the University of California San Diego Moores Cancer Center. A 27-item Qualtrics questionnaire was distributed by email to attending physicians, fellows, and advanced practice providers across surgical, medical, radiation, and palliative oncology. Survey domains included telehealth coordination, technical quality, communication effectiveness, confidence in remote physical examination, and factors influencing visit modality selection. Quantitative responses were summarized descriptively, and open-ended responses underwent thematic analysis. Results: Among 114 invited clinicians, 57 (50%) complete responses were analyzed. Among 57 respondents, 86% (n=49) were physicians. Specialties included surgical oncology (n=21, 36.8%), medical oncology (n=18, 31.6%), radiation oncology (n=16, 28.1%), and palliative care (n=2, 3.5%). Telehealth coordination was rated easy or very easy by 78.9% (n=45) of clinicians. Audio and video quality were rated good or very good by 71.9% (n=41) and 57.9% (n=33), respectively. Technical issues prompted at least occasional conversion to audio-only visits for 86% (n=49) of respondents, and 17.5% (n=10) of clinicians reported frequent conversion. Communication satisfaction was high (n=48, 84.2%), yet only 50.9% (n=29) reported moderate or high confidence in performing a virtual physical examination. The need for physical examination (n=53, 93%) and patient travel distance (n=45, 78.9%) were the most influential factors in offering telehealth visits. Confidence varied by specialty and clinical phase: moderate or high confidence was reported by surgical oncology clinicians in 52.4% (11/21) of preoperative and 71.4% (15/21) of postoperative responses, by medical oncology clinicians in 77.8% (14/18) of prechemotherapy and 76.5% (13/17) of during chemotherapy responses, and by radiation oncology clinicians in 87.5% (14/16) of preradiation and 93.8% (15/16) of during radiation responses. Conclusions: Oncology clinicians reported generally positive experiences with telehealth, although confidence and use patterns varied across specialties and phases of care. Telehealth is viewed as a complementary modality when physical examination is not essential. Improvements in technical reliability and interpreter integration may enhance equitable access and support continued telehealth use in oncology care.

Introduction: We evaluated the incidence of anxiety, depression, and suicidality amongst TC survivors and the impact of chemotherapy on these outcomes. Methods: We conducted a retrospective cohort study of men diagnosed with TC in the United States Veterans Affairs Health System from 1990 to 2016. De novo anxiety or depression was a composite endpoint comprised of diagnosis codes for anxiety, depression, or medications used to treat these diagnoses. Incident suicidality was defined as a diagnosis code for suicidal ideation. 2022 TC patients were compared in a 1:3 ratio to 6375 controls. Cox proportional hazards models were employed for statistical analysis. Results: Mean age at diagnosis was 42.6 years. 5‐year cumulative incidence of anxiety or depression was 53.4% in TC patients and 35% for controls ( p < 0.001). TC patients were more likely to develop anxiety or depression (HR 1.66, 95% CI 1.56–1.78, p < 0.001) and suicidality (HR 22.99, 95% CI 17.52–30.17, p < 0.001). In the TC cohort, factors associated with a higher risk of anxiety or depression were divorce (HR 1.15, 95% CI 1.00–1.32, p = 0.044), unemployment (HR 1.68, 95% CI 1.47–1.9, p < 0.001), and receipt of chemotherapy (HR 1.20, 95% CI 1.06–1.35, p < 0.001). Conclusions: Psychological morbidity due to depression, anxiety, and suicidality is high among TC survivors. In our analysis chemotherapy increases the rates of psychosocial morbidity. Clinicians should be proactive in screening and intervening for these diagnoses in TC survivors to provide early intervention and improve health comes.

Molecular profiling of testicular germ cell tumors (TGCTs) provides critical insights into personalized treatment approaches, particularly for patients with recurrent or treatment-resistant disease. In this study, we retrospectively analyzed clinicopathological and targeted genomic sequencing data from 27 TGCT patients, including 7 seminomas, 19 non-seminomas, and 1 prepubertal type teratoma, across stage I (48%), stage II (41%), and stage III (11%). Tumor samples were obtained from 27 orchiectomies, with additional pathological specimens collected from 16 of these patients during retroperitoneal lymph node dissections (RPLNDs); these included 8 chemotherapy-naïve and 8 post-chemotherapy cases. The median tumor mutational burden (TMB) was 0.5 mutations/Mb, consistent with the low mutation rate typically observed in TGCTs. Somatic mutations and copy number gain alterations were detected in 56% (15/27) of patients, primarily in KRAS (25.9%), KIT (11.1%), and PIK3CB (7.4%). PD-L1 positive immunoreactivity by immunohistochemistry was observed in 75% of tumors (60% in stage I, 100% in stage III) analyzed (n = 8), suggesting potential immune checkpoint inhibitor applicability in advanced disease. Microsatellite instability (MSI) status was identified in 23 tumors; all were classified as MSI-low, supporting the rarity of MSI-driven tumorigenesis in TGCTs. Actionable gene alterations linked to FDA-approved therapies, interventional therapies, and clinical trials in TGCTs and other cancers (lung, skin, colon, liver, stomach, and breast) were present in 59.3% (16/27) of patients, indicating potential therapeutic repurposing. Additionally, germline variants of uncertain clinical significance in known cancer actionable genes, including MSH2, MSH6, RB1, and BRCA2, were found in 9 patients, warranting further investigation regarding their clinical relevance and susceptibility risk. Our findings highlight that a substantial proportion of TGCT patients harbor potentially actionable molecular alterations across all disease stages.

Background: The 5‐year survival rate for patients with testicular germ cell tumors (TC) is excellent. However, these survivors are at an increased risk for metabolic syndrome (MetS), a significant source of morbidity and precursor to cardiovascular disease. This study investigates the incidence of MetS in TC survivors compared to matched controls.Methods: A retrospective analysis was conducted using the Veterans Affairs national database. The incidence of MetS was compared between 2021 TC survivors and 7595 matched controls. MetS was identified via diagnostic codes and medication use, requiring at least three of five criteria: insulin resistance, dyslipidemia, central obesity, and hypertension. Statistical analysis included chi‐squared and t‐tests for demographic comparisons, and Cox regression for outcome associations.Results: TC survivors exhibited a greater prevalence of MetS components than controls, specifically hyperglycemia (28.4%), low HDL levels (59.8%), hypertriglyceridemia (8.0%), and abdominal obesity (27.3%), except for hypertension. Over 5 and 10 years, the cumulative incidence of MetS in TC survivors was 17.0% and 27.8%, compared to 1.9% and 2.8% in controls. Multivariate regression showed an increased incidence of MetS in TC survivors (HR = 19.02, 95% confidence interval [CI]: 16.31–22.19, p < 0.001). Chemotherapy (HR = 1.28, 95% CI: 1.04–1.57, p = 0.017) and increasing age (HR = 1.04, 95% CI: 1.04–1.06, p < 0.001) were associated with a higher risk.Conclusions: TC survivors have a substantial risk of MetS with a higher occurrence of most MetS components, barring hypertension. Comprehensive metabolic health monitoring is crucial in TC survivorship care. Integrating vigilant screening and preventive strategies can mitigate MetS development in this population.

Objectives: The incidence of renal cell carcinoma (RCC) has been rising, largely due to increased incidental detection from widespread imaging. Although synchronous distant metastasis (SM) with a primary renal tumor measuring p = 0.830). The most common sites of metastasis were bone (59%), followed by lung (35%), liver (16%), and brain (12%). Resection of the primary tumor and receipt of systemic therapy were significantly associated with reduced mortality among all metastatic sites, especially in individuals with lung-only metastases (HR = 0.02, p = 0.013). Metastasectomy was associated with improved survival in patients with brain-only metastases (HR = 0.26, p = 0.006) but did not demonstrate the same benefit in patients with bone-, lung- or liver-only metastases. The worst 5-year OS rate was observed in cases with metastasis to multiple sites, whereas isolated metastases had similar survival rates (p < 0.0001). Our findings are limited by retrospective study design. Conclusions: This comprehensive analysis of T1a RCC patients reveals that while synchronous metastasis is relatively uncommon (2.0%), it presents significant clinical challenges, with bone as the most common metastatic site, contrasting with the typical lung predominance in larger tumors. Primary tumor resection showed survival benefit in patients with isolated metastases, especially for lung-only metastasis. These findings highlight the heterogeneous nature of tumor biology in small renal masses and underscore the importance of tailored, multimodal treatment strategies for the effective management of SM T1a RCC.

Importance: The National Cancer Database (NCDB) is an invaluable and widely used resource for cancer research, but the current state of representation of different racial and ethnic groups compared with the United States Cancer Statistics (USCS) database is unknown.Objective: To examine whether Hispanic and American Indian or Alaska Native individuals have lower representation in the NCDB compared with the USCS database.Design, Setting, and Participants: This multicenter, retrospective cohort study assessed individuals diagnosed with breast, colorectal, lung, and prostate cancer from January 1, 2004, to December 31, 2006, and January 1, 2017, to December 31, 2019, in the NCDB and USCS databases. Data analysis was performed from September 2022 to October 2023.Exposure: Time.Main Outcomes and Measures: The primary outcome was the absolute percentage change (APC) in capture rate across the study period.Results: The cohort included 5 175 007 individuals (0.50% American Indian or Alaska Native, 3.10% Asian or Pacific Islander, 12.01% Black, 6.58% Hispanic, and 77.81% White) who were diagnosed with breast, colorectal, lung, and prostate cancer. Capture rates were the lowest for individuals who were Hispanic (40.83% in 2004-2006 and 54.75% in 2017-2019; P < .001) or American Indian or Alaska Native (20.72% in 2004-2006 and 41.41% in 2017-2019; P < .001). The APCs were positive for both racial categories across all 4 cancers. However, overall APCs for Hispanic individuals (13.92%) remained lower than the overall APCs of White individuals (22.23%; P < .001). The APCs were greater for American Indian or Alaska Native individuals than for White individuals for prostate (14.68% vs 11.57%) and breast (21.61% vs 17.90%) cancer (P < .001), but the APCs for American Indian or Alaska Native individuals were lower than for White individuals for lung cancer (24.54% vs 33.03%; P < .001).Conclusions and Relevance: In this cohort study of individuals diagnosed with cancer in the NCDB, Hispanic and American Indian or Alaska Native individuals diagnosed with breast, colorectal, lung, and prostate cancer were undercaptured in the NCDB, but their representation improved over time. Increased study is needed to determine where these populations predominantly seek cancer care.